Immediate and Long-term Career goals. Immediate goals are to 1) Develop the knowledge and Technical research skills necessary to study the psychological, immunological, and neuroendocrine factors involved in pain perception and processing; 2) Estimate the effects of psychosocial factors on low-back and neck pain prognosis; and 3) learn how cytokines, hormones and neuropeptides mediate these effects. Longterm goals are to: 1) use this knowledge to test hypotheses regarding the interrelationships of pain and pain related disability to psychosocial, behavioral, and immunological factors; 2.make significant contributions to out understanding of the etiology of pain-related disorders and the relationships between inflammatory mediators, nociception and hypothalamic-pituitary-adrenal axis activation, and hyperalgesia, stress-related behaviors and depression and 3) develop more effective clinical interventions tailored to each patient?s pain, physical and psychological function, immune and neurendocrine status, and related behavior. Research Career Development Plan. The plan includes: 1) didactic training in psychological, neurology, immunology and endocrinology of pain processing and pain perception; 2) Training in laboratory methods used to assess the immune and neuroscience systems in clinical studies; 3) supervised analysis of clinical trial data to estimate the effects of psychosocial factors on low-back and neck-pain prognosis and to estimate their effects on outcomes; 4) Planning and execution of pilot studies to assess how psychosocial, behavioral and immune factors affect pain perception and response to pain and other stressors, integrating biochemical and other measures; and 5) development of independent investigator-initiated grant proposals. Research Project: The proposed project is designed to assess the effects of psychological distress and well-being, social support, and pain coping strategies on the course of low-back pain in a managed health-care population receiving medical or chiropractic care for their symptoms. This will be the first study to estimate the effects of these psychosocial factors on both short and long term pain prognosis, and the first to assess their influence on the effects of chiropractic and medical care in a large, diverse patient population. Findings from these analyses, with the results of studies of neuroscience and immune factors and pain, will be used to design follow-up projects to study the interrelationships between psychosocial, behavioral, and immune factors and their influence on the onset and continuation of musculoskeletal pain.